Approved, SCAO JIS CODE: CAC STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION FILE NO. CONSENT TO ADOPTION BY ADOPTEE COUNTY In the matter of Full name DOB: , adoptee 1. I understand that my consent is necessary for this adoption. 2. The judge or referee of the court has fully explained to me that I do not have to sign this consent. 3. I consent to my adoption by Name and Name and I consent to taking the above permanently as my legal parent(s), as though parent(s) by birth. 4. I understand that I shall no longer be an heir of my former parent(s), whose rights have been terminated, except if this is a stepparent adoption, in which case I remain an heir of my biological parent whose rights were terminated, and I also become an heir of my adopting parent. 5. I agree that following adoption my name will be . Date Adoptee signature Adoptee name (type or print) Address City, state, zip After the court made the investigation it deemed necessary, I fully explained to the adoptee the fact that s/he was consenting to acquire permanently the adopting parents as legal parents as though the adoptee had been born to the adopting parents, and consenting to the termination of right to be an heir at law of his/her former parent(s) whose rights have been terminated.* The adoptee then voluntarily signed this consent before me. A verbatim record of testimony was made. Date Judge/Referee Bar no. *In adult adoptions, see current law in MCL 710.60. Do not write below this line - For court use only PCA 307 (2/15) CONSENT TO ADOPTION BY ADOPTEE American LegalNet, Inc. www.FormsWorkFlow.com MCL 710.43, MCR 3.801